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Multicenter Study
Use of dosage as a triage guideline for unintentional cyclic antidepressant (UCA) ingestions in children.
- Henry A Spiller, S David Baker, Edward P Krenzelok, and Letizia Cutino.
- Kentucky Regional Poison Center, Louisville, Kentucky 40232, USA. henry.spiller@nortonhealthcare.org
- Am J Emerg Med. 2003 Sep 1; 21 (5): 422-4.
AbstractTriage guidelines for unintentional cyclic antidepressant (UCA) ingestions vary widely, with limited supportive evidence. All records of UCA ingestion reported to 4 certified regional poison centers were evaluated for the years 1998 through 2000. Inclusion criteria included age =6 years patients with a known outcome and known ingested dose by history. Exclusion criterion was polydrug ingestion. Two hundred forty-six cases were evaluated. The mean age was 2.4 years (standard deviation, +/-1.2 y). One hundred thirty-six patients (55%) were managed in a hospital. One hundred ten patients were managed at home with observation and telephone follow up. Symptoms reported were drowsiness (n = 59), tachycardia (n = 4), agitation (n = 2), coma (n = 2), respiratory depression (n = 1), and ataxia (n = 1). Medical outcome was reported as no effect (n = 185; 75%), minor effect (n = 57; 23%), moderate effect (n = 2; 1%); and major effect (n = 2; 1%). Mean dosage of patients with and without symptoms was 6.3 mg/kg (+/- 9.3) and 2.9 mg/kg (+/- 3.1), respectively. Forty-three of 57 patients (75%) with minor symptoms reported a dosage of <5 mg/kg. All patients with a moderate or major outcome (n = 4) reported a dosage of >5 mg/kg. The majority of UCA ingestions produced limited or no symptomatology. In this series, all children with ingestions of <5 mg/kg developed no or minor effects. Home monitoring might be appropriate in such cases.
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